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Nhận xét một số điểm khác biệt giữa nhóm thai phụ chẩn đoán ĐTĐ rõ lần đầu phát hiện trong thời kỳ mang thai và nhóm ĐTĐ thai kỳ_Tiếng Anh

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• Early screening of gestational diabetes, especially in high-risk pregnant women, should be used to detect early gestational diabetes and reduces morbidity for bot[r]

(1)(2)

INTRODUCTION

 GDM is rapid rising worldwide, especially in the Asia region

 The prevalence of GDM varies from 8,9 – 53,4%:

 New criteria by the IADPSG on diagnosis of GDM

 Increment in the prevalence of obesity and T2DM in young women

(3)

INTRODUCTION

 The HAPO study showed a positive correlation between maternal hyperglycemia level and adverse maternal, fetal, and/or neonatal outcomes

 Higher levels of maternal glucose with no defined levels, after which the risk increases

(4)

INTRODUCTION

 The IADPSG proposed the following definition for overt diabetes during pregnancy (ODM): pregnant women who meet the criteria for diabetes in the nonpregnant state but were not previously diagnosed with diabetes

 Women with ODMP are newly defined as having:

 Fasting glucose ≥ 7,0 mmol/l

 or 2h post OGTT glucose ≥ 11,1 mmol/l

(5)

INTRODUCTION

• Thus, types of glucose intolerance are identified in pregnancy: GDM and ODM

• Our hypothesis is that ODM would have a more severe glycemic disturbance and increased risk of both maternal and neonatal complications

• However, little has been reported regarding differences in pregnancy outcomes between these groups

(6)

Patients and methods

• Patients and methods: The study conducted from 11/2014 to 7/2015 in Endocrinology - Bach Mai Hospital Data were collected on 283 women in the study including 104 with overt diabetes and 179 women with gestational diabetes These women were examined, managed blood glucose by modifying lifestyles and dietor insulin treatment until the end of pregnancy

(7)

Patients and methods

Choose group for study:

GDM: (ADA 2011) 75 g OGTT at 24–28 weeks gestation

 Fasting glucose: ≥ 5,1 mmol/l

 1h post OGTT glucose: ≥ 10,0 mmol/l

 2h post OGTT glucose: ≥ 8,5 mmol/l

ODM: (ADA 2011)

 Fasting glucose ≥ 7,0 mmol/l

(8)

Patients and methods

We excluded from the study:

Women with multiple fetal gestations, pre-gestational diabetes, history of previous treatment for gestational

diabetes, active chronic systemic disease other than

chronic hypertension, women with the second of

(9)

Patients and methods

Question:

 Age (yrs)

 BMI before pregnancy (kg/m2)

 Gestational weight gain (kg)

 Gestational age at diagnosis (wk)

(10)

Patients and methods

Exam:

 Blood pressure:

 BMI

Sub – clinical:

 75 g OGTT at 24–28 weeks gestation

 HbA1C

(11)

Patients and methods

TREATMENT:

 Insulin therapy

 Max insulin dose

 Treatment goals (ADA 2011)

 Fasting glucose : ≤ 5,3 mmol/l

(12)

Patients and methods

Adverse pregnancy outcomes: • Polyhydramnios

Preterm birth Hypertension

(13)

Patients and methods

Adverse pregnancy outcomes • Large-for-gestational age • Small-for-gestational age • Hypoglycemia

• Apgar

(14)

ODM ( n = 104)

GDM ( n = 179)

p

Age (y) 31.5 ± 4.3 30.3 ± 5.8 p > 0.05

BMI (kg/m2) 22.6 ± 3.2 20.8 ± 5.8 p < 0,05

Baseline characteristics

Tuổi: Wong, Sugiyama không khác biệt Sumin có khác biệt BMI: Khác biệt Wong, Sugiyama, Sumin

(15)

Results and discussion

ODM n = 104

GDM n = 179

p

Gestational age at diagnosis (wk) 27.4 ± 6.4 26.1 ± 1.9 p > 0.05 Gestational weight gain (kg) 10.1 ± 4.6 11.2 ± 3.5 p > 0.05

(16)

Results and discussion

ODM

n = 104

GDM

n = 179 p

Yes – n (%) 76 (73,1 %) 50 (27,9 %) p < 0.01

No – n (%) 28 (26,9 %) 129 (72,1 %)

(17)

0 10 15 20 25 30 35 40

Family history of diabetes

BMI ≥ 23 A history of delivering big

baby

Glucosuria Past history of GDM

Glucose tolerance disorder

40

34

21 20

10

6 14

24

8

2

1

ODM GDM

p < 0.01

Số thai phụ

Results and discussion

(18)

Results and discussion

Đặc điểm ODM

n = 104

GDM n = 179

p Antenatal oral glucose tolerance

test (fasting result) (mmol/l) 7.4 ± 2.6 5.1 ± 0.4 p< 0.001 Antenatal oral glucose tolerance

test (2-h result) (mmol/l) 13.4 ± 2.1 9.2 ± 2.8 p< 0.001 HbA1C (%) 6,6 ± 1,2 5.2 ± 0.3 p< 0.01

Ceton urinary 18(17.3%)

(19)

Results and discussion 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ODM GDM

77.9%

6.7% 22.1%

93.3%

Insulin therapy

Insulin therapy – no

Insulin therapy

(20)

Results and discussion

ODM

n = 104

GDM

n = 179 p RR

Reach treatment goals n = 231

76 73.1 %

155 86.6 %

p < 0.01

2.4 (1.3 – 4.4) No reach treatment goals

n = 52

28 26.9 %

24 13.4 %

(21)

Results and discussion

ODM

n = 86

GDM

n = 179 p

Gestational age at delivery (wk) 38.2 ± 1.6 39.0 ± 1.3 p < 0.01

Birth weight (g) 3.3 ± 0.6 3.2 ± 0.5 p > 0.05 Cesarean section – n (%) 66 (76.7%) 114 (80.4%) p > 0.05

(22)

ODM n = 86

GDM n = 179

p RR

95% CI

Yes - n 51 58 < 0.001 1.8

(1.4 – 2.4)

% 59.3% 32.4%

Adverse pregnancy outcomes

(23)

ODM n = 86

GDM n = 179

p

RR 95% CI

Polyhydramnios 19 (22.1) 23( 12.8) > 0.05 1.7 (0.9 – 2.8)

Preterm birth 22 ( 25.6) 18 (10.1) < 0.01 2.5 (1.4 – 4.5) Hypertension – n (%) 11 ( 12.8) 5 ( 2.8) < 0.01 4.6 (1.6 – 12.7)

Pre-eclampsia and Eclampsia

6 (7.0) (0.6) < 0.05 -

Stillbirth 1(1.2) 1(0.6) - -

Maternal complications

Results and discussion

(24)

ODM n = 86

GDM

n = 179 p

RR 95% CI

LGA – n (%)* 10 (11.6) 10(5.6) p > 0.05 2.1 (0.9 – 4.8) SGA – n (%)** (10.5) 10 (5.6) p > 0.05 1.9 (0.8 - 4.4)

Hypoglycemia – n (%) 5 (5.8) 2 ( 1.1) p < 0.05 5.2 (1.0 - 25.2)

Congenital

malformations – n (%)

4 (4.7) (0.6) p > 0.05 -

Neonatal death 1(1.2) - - RDS – n (%)*** 1(1.2) - -

Neonatal complications

Sugiyama khơng khác biệt tỉ lệ HĐHSS Wong có khác biệt tỉ lệ HĐHSS

Results and discussion

(25)

Conclusions

• Most of the women in the groups overt diabetes have high risk factors (73,1%)

• GDM just control blood glucose with diet (93.3%) 77.9% of ODM group need insulin to control blood glucose

• ODM have rate of complications for mother and fetus is higher than GDM (59.3% versus 32.45%, p <0.01)

(26)

Recommendation

(27)

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